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Obesity strongly predicts clinically undetected multiple lymph node metastases in intermediate- and high-risk prostate cancer patients who underwent robot assisted radical prostatectomy and extended lymph node dissection

  • Urology - Original Paper
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Abstract

Objective

To evaluate the association between obesity and risk of multiple lymph node metastases in prostate cancer (PCa) patients with clinically localized EAU intermediate and high-risk classes staged by extended pelvic lymph-node dissection (ePLND) during robot assisted radical prostatectomy (RARP).

Materials and methods

373 consecutive PCa intermediate or high-risk patients were treated by RARP and ePLND. According to pathology results, extension of LNI was classified as absent (pN0 status) or present (pN1 status); pN1 was further categorized as one or more than one (multiple LNI) lymph node metastases. A logistic regression model (univariate and multivariate analysis) was used to evaluate the association between significant categorized clinical factors and the risk of multiple lymph nodes metastases.

Results

Overall, after surgery lymph node metastases were detected in 51 patients (13.7%) of whom 22 (5.9%) with more than one metastatic lymph node and 29 (7.8%) with only one positive node. Comparing patients with one positive node to those without, EAU high-risk class only predicted risk of single LNI (OR = 2.872; p = 0.008).

The risk of multiple lymph node metastases, when compared to cases without LNI, was independently predicted by BMI ≥ 30 (OR = 6.950; p = 0.002) together with BPC ≥ 50% (OR = 3.910; p = 0.004) and EAU high-risk class (OR = 6.187; p < 0.0001). Among metastatic patients, BMI ≥ 30 was the only factor associated with the risk of multiple LNI (OR = 5.250; p = 0.041).

Conclusions

In patients with clinically localized EAU intermediate and high-risk classes PCa who underwent RARP and ePLND, obesity was a risk factor of multiple LNI.

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Authors and Affiliations

  1. Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Ospedale Civile Maggiore, Polo Chirurgico Confortini, Piazzale Stefani 1, 37126, Verona, Italy

    Alessandro Tafuri, Nelia Amigoni, Riccardo Rizzetto, Marco Sebben, Alessandra Gozzo, Katia Odorizzi, Mario De Michele, Sebastian Gallina, Alberto Bianchi, Paola Ornaghi, Vincenzo De Marco, Filippo Migliorini, Maria Angela Cerruto, Walter Artibani, Alessandro Antonelli & Antonio Benito Porcaro

  2. Department of Neuroscience, Imaging and Clinical Sciences, ‟G. D’Annunzio″ University, Chieti-Pescara, Italy

    Alessandro Tafuri

  3. USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA

    Alessandro Tafuri & Aliasger Shakir

  4. Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy

    Matteo Brunelli

  5. Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy

    Vittore Verratti

Authors
  1. Alessandro Tafuri
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  2. Nelia Amigoni
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  3. Riccardo Rizzetto
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  4. Marco Sebben
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  9. Sebastian Gallina
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  18. Alessandro Antonelli
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  19. Antonio Benito Porcaro
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Correspondence to Antonio Benito Porcaro.

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Tafuri, A., Amigoni, N., Rizzetto, R. et al. Obesity strongly predicts clinically undetected multiple lymph node metastases in intermediate- and high-risk prostate cancer patients who underwent robot assisted radical prostatectomy and extended lymph node dissection. Int Urol Nephrol 52, 2097–2105 (2020). https://doi.org/10.1007/s11255-020-02554-3

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